Performance Work Statement HCHV Services v1.0.docx

VA Wilmington

PERFORMANCE WORK STATEMENT

HEALTH CARE FOR HOMELESS VETERANS

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS

1) PURPOSE:

The Wilmington Veterans Affairs Medical Center (WVAMC) is seeking a contractor to provide services to support emergency housing services as part of our Health Care for Homeless Veterans (HCHV) programs in Atlantic County, New Jersey. The goal of the HCHV program is to remove Veterans from the street and other areas not meant for habitation and provide placement in a community-based, residential environment with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation.

The contractor shall provide housing, outreach, case management, and rehabilitative services in Atlantic County, New Jersey (Wilmington VAMC) for Veterans experiencing homelessness and/or chronic homelessness as defined by the Housing and Urban Development (HUD), including Veterans diagnosed with severe mental illness and substance use disorders in community-based treatment facilities.

2) BACKGROUND:

The VA has been providing direct and specialized services for homeless Veterans for more than 30 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the plan to end homelessness among Veterans announced in late 2009, the Veterans Health Administration (VHA) has increased both capacities of existing programs and services offered to program participants.

The goal of the Healthcare for Homeless Veterans (HCHV) program is to provide housing and case management services to Veterans and facilitate their assets to a broad range of medical, mental health, and rehabilitative services utilizing “low demand” model guidelines. The goal of the HCHV Contracted Residential Services (CRS) is to rapidly stabilize Veterans’ medical, mental health, substance abuse, and other psychosocial problems with a goal to place Veterans in appropriate transitional or permanent housing within 90 days, not to exceed 180 days without clinical justification.

The target population for this HCHV Contract Residential Care is chronically homeless, chronically mentally ill Veterans with chronic substance abuse disorders and complex needs.

3) Definitions:

Chronic Homelessness is defined as HUD in 24 CFR parts 91 and 578 to mean a homeless individual with a disability who lives either in a place not meant for human habitation, a safe haven or in an emergency shelter immediately before entering the institutional care facility. To meet the “chronically homeless” definition, the individual must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last three years, where the combined experiences total a length of time at least 12 months. Each period separating the experiences must include at least seven nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or a safe haven.

Contracting Residential Services (CRS) is a community-based early recovery model of supportive housing that serves hard to reach, hard to engage homeless individuals with severe mental illness and substance use disorders. Many have not been able to comply with traditional program requirements resulting in a high number of emergency rooms and acute care services and more Veterans living on the streets or shelters. CRS places no treatment participation demands on residents but expect a transition from unsafe and unstable street life to permanent housing and re-engage with treatment services.

CRS are 24-hour staffed transitional residencies with private or semi-private accommodations that target the population of hard-to-reach, chronically homeless Veterans with mental illness and substance use problems who require a low-demand environment. The low-demand or non-intrusive environment is designed to re-establish trust and motivate the homeless Veteran to seek the needed treatment services and transitional and permanent housing options. The length of stay in program are typically 90 days not to exceed 180 days without clinical justification.

4) PROGRAM REQUIREMENTS:

a) The Contractor must have an adequate facility in Atlantic County, New Jersey. The residence must have 10 up to 15 beds for males. The contractor shall provide all labor, supervision, housing, material, and supplies necessary to provide emergency residential placement, treatment, and supportive services through the HCHV program model. The contractor will offer a low-demand environment with a minimum set of rules designed to re-establish trust and engage the Veteran in needed treatment services.

b) The following CANNOT be conditions of admission or continued stay:

i) Acceptance of treatment

ii) Medication adherence or compliance

iii) Abstinence from alcohol or drugs

iv) Income or lack thereof

v) Legal history

vi) The time interval since the last program entry

vii) Infractions of rules should be used as opportunities for engagement.

5) SERVICES TO BE PROVIDED: The Contractor shall furnish each Veteran who has been approved as eligible by the VA and admitted for care under this contract with the following basic services:

a) Room and board:

i) Room and Board shall include a private or semi-private room with a bed and other furnishings for seven days a week and 24 hours per day, such as a dresser, storage, locking closet, and locking armoire, a locker, etc., and personal linens (towels, blankets, and bedsheets). The bed must be designated for use exclusively by the individual Veteran from the time of admission to the time of discharge. The bed and mattress must be situated in a room that affords the Veteran safety, privacy, and security. The contractor must follow current dietary guidelines set forth by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, including updates to the policies. Food shall be prepared, served, and stored under sanitary conditions. The contractor shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The contractor shall establish and maintain hygienic procedures for washing dishes, cleaning equipment, work areas, and disposing of waste. There will be a minimum of three meals per day plus snacks available, provided by the contractor. Also, there will be the availability of snacks of nourishing quality (e.g., fruits, vegetables, protein sources, etc.) between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than 14 hours between the evening meal and breakfast of the following days. The contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g., diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g., Kosher, Sikh, etc.). The VA has a particular concern for chronically homeless Veterans, many of whom are either undernourished or have developed poor eating habits or both because of chronic medical, mental health, or substance abuse disorders. A VA dietitian may assess printed menus and Veterans’ satisfaction with meals and the actual consumption of food offered in determining the Contractor’s success in meeting this requirement during annual facility inspection or at any point during the contract period.

b) Laundry Facilities:

i) Laundry facilities and necessary detergent shall be free of charge and adequate for residents to do their own laundry or to have laundry done at a minimum one time per week.

c) Internet and Computer Assess:

i) Internet assets shall be available to Veterans residing at the facility. Access shall consist of a service/speed rating of at least 10 Megabytes per second (Mbps) Download, 1 Mbps Upload or better. Wireless or another permit shall be provided so that three (3) or more users can access internet services simultaneously. The facility shall provide hardware (computer(s), printer, etc.) to be utilized. Veterans enrolled at the local community college or taking online courses should be given priority of usage. The Contractor will be responsible for establishing hours of use and setting any “parental controls” they deem essential.

d) Environment of Care:

i) The Contractor must provide a clean and comfortable environment of care that is a structurally sound facility. The facility shall not pose any threat to the occupants’ health and safety and protects from the elements. The facility entries and exit locations for every room or space will have natural or mechanical ventilation; be free of projects in the air at levels that threaten the health of Veterans; provide a water supply free from contamination; have sufficient sanitary facilities in proper operational condition; allowed to be used in privacy and are adequate for personal cleanliness and the disposal of human waste. The facility must have sufficient heating and or cooling mechanisms that are in proper operating condition; adequate natural or artificial illumination to permit normal indoor activities and to support the health and safety of Veterans; provides good electrical sources to enable the use of essential electrical appliances while assuring safety from fire. All housing and equipment will be maintained in a sanitary manner free from pests, insects, and vermin and will provide a warm, welcoming, and respectful atmosphere through lighting and décor. The Contractor ensures that furniture is well maintained and comfortable. It is the Contractor’s responsibility to maintain a clean and comfortable environment that meets these conditions. For example, the Contractor would be responsible for alleviating a bed bug infestation by hiring an exterminator at its own expense.

e) Facility:

i) It is the Contractor’s responsibility to maintain its facilities properly, and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must:

(1) Pass VA NFPA inspection

(2) Must meet ADA requirements.

(3) Have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located.

(4) Comply with State and local safety codes and State health and sanitation codes.

(5) Be licensed under the State or local authority.

(6) Where applicable, be accredited by the State.

(7) Be equipped with operational air conditioning/heating systems.

(8) Be kept clean free of dirt, grime, mold, or other hazardous substances, and damaged noticeably detract from the overall appearance.

(9) Be equipped with first aid equipment and an evacuation plan in case of emergency.

(10) Have windows and doors that can be opened and closed by manufacturer’s standards.

(11) Have an aggressive on-going plan to address bed bug infestation. The policy must be a part of your written response to this solicitation. On-going bed bug infestation will be grounds for immediate discharge of Veterans from the facility.

f) Reasonable Accommodation:

i) The Contractor must respect and reasonably accommodate personal and cultural differences associated with race, religion, creed, color, national, origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation. At no point shall program access be denied because of an individual’s disability. Information learned about the Veteran’s disability from the assessment will not be used as grounds for discharge or other punishment and will guide the Veteran to appropriate services. Moreover, a program may not apply different rules to Veterans because of their disabilities unless the different rules result from granting a reasonable accommodation request made by a Veteran with a disability. The Contractor shall not ask questions about a Veteran’s disability including the nature and severity of the disability, or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that she/he has a disability before admission. Veterans with disabilities are entitled to reasonable accommodation. If a Veteran requests a change in a program’s policy or procedure as an accommodation to his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the Veterans’ Disability. Such an accommodation request must be considered during any stage in providing a program, including at intake, during services, and during discharge proceedings. When reasonable accommodation is made, the program supervisor may request verification of the individual’s disability. The Contractor is required to develop a written policy for their process for reasonable accommodations. This will include:

ii) All requests for reasonable accommodation,

(1) Details of all steps taken to accommodate a Veteran’s claim for reasonable accommodation,

(2) Any explanation for denial of services and accommodation and,

(3) Any appropriate referrals to Veterans who are denied accommodation.

iii) All explanations are to be written on formal letterhead from program management to the Veteran and VA Liaison at the time of denial for services or accommodation. The Contractor will be aware that violation of the ADA, Section 504 of Rehabilitation Act, and Fair Housing Laws may stop admissions and terminate the contract for cause.

g) On-site office space for VA Liaison:

i) The Contractor must provide designated onsite furnished office space to a VA Liaison or other VA-clinical staff from VA as needed. The office space must afford the VA Liaison and Veterans privacy and confidentiality when meeting.

h) Transportation:

i) The Contractor will ensure that transportation is available between the hours of 0600 to 1800 seven days per week for Veterans to attend medical/mental health appointments, search for transitional or permanent housing, and address other care needs. This can be done by providing bus passes, utilization of cab services, or contractor facility transportation. These costs will be considered part of the essential services provided. Veterans that are experiencing a non-life-threatening emergency and wish to seek treatment shall be brought to the WVAMC emergency room at any time and contractor shall offer transportation options that are at no cost to Veteran.

i) Outreach:

i) Outreach will be conducted by the contractor staff in conjunction with street outreach teams within the community and VA staff. It will target chronically homeless Veterans who have difficulty accepting housing and services from traditional programs. Homeless Veterans with severe mental illness and persistent substance use problems that have not responded to traditional programs and meet the definition of a chronically homeless person are a primary target. For this program, we will use the U.S. Department of Housing and Urban Development’s working description of a chronically homeless person as one who “ in general is an unaccomplished disabled individual who was continuously homeless for over one year.” Engagement with the Veteran should be goal-directed with consistent staff geared toward building trust and getting the Veteran to accept and remain at the residence. Evidence-based practices, such as Motivational interview, Harm Reduction, and Critical Time Intervention, should be utilized.

j) Medication Management:

i) Medication and narcotics shall be stored appropriately, controlled, issued, and recorded according to physician’s orders. The Contractor shall establish procedures for ensuring Veterans confidentiality in the storage of and keeping records concerning medication. Medication-Assisted Treatment (MAT) cannot be used to rule out Veterans participation in either of the CRS Programs. Including prescribed use of Vicodin, Morphine, Methadone, Oxygen, etc. Reasonable accommodation for individuals in MAT is required, provided the requested accommodation does not require significant financial or administrative commitment that would be considered an “undue burden.”

ii) Examples of reasonable accommodation include:

(1) Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location-when consistent with the individual’s treatment plan.

(2) Storing an individual’s MAT medication in a lockbox in the program and having the individual be personally responsible for it.

(3) Arranging to have the housing facility keeping MAT medication in a locked cabinet.

k) Therapeutic and Rehabilitative Services:

i) The Contractor shall provide, at a minimum, the following services to Veterans in the program.

ii) Group Activities:

(1) Structured group activities, as appropriate, shall occur at least two times per month in-person, on site, examples include group therapy, like skills training, social skills training, financial workshops, Alcoholic Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate. For this contract, “House Meetings” and VA Housing Resource Groups may not be counted as a structured group activity. Group Activities should have a therapeutic value, and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental, health, medical, family, and/or employment obligations that directly conflict with this requirement, alternate group activities will be arranged. The Contractor will document the efforts made to accommodate the Veteran.

l) VA Coordination:

i) The Contractor will coordinate with the VA Liaison during weekly conferences regarding updates and changes in Veterans’ care plans to foster a collaborative relationship with the VAMC and Contractor to ensure Veterans’ connections to needed VA medical, mental health, and substance abuse treatment and care. Case Conferencing may be done in person, by telephone conference calls or through virtual platforms as determined by VA staff.

6) CASE MANAGEMENT SERVICES:

a) The Contractor will work with the Veteran in the service planning process, which includes responsibility for interviewing, counseling, and case managing identified Veterans by conducting psychosocial assessments to determine treatment needs that affect the Veterans’ adjustment to their environment and case management, including short and long-term services.

b) The Contractor will assess the psychosocial and environmental needs secondary to or exacerbating the social, substance, or psychiatric problems, which might contribute to Veterans’ readjustment challenges in the community. The Contractor establishes and maintains an intensive therapeutic relationship with the Veteran, staff, and community programs/agencies and is responsible for formulating case-management treatment goals and plans that address identified needs, stressors, and problems. Psychosocial assessments will include goals for clinical treatment.

c) The Contractor will conduct high-risk screening, psychosocial assessment and treatment planning, an activity involves the Veteran and their family or significant others, in coordination with the team members.

d) The Contractor coordinates and documents clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided.

e) The Contractor will work with the Veteran to develop a written Individualized Service Plan (ISP) developed within 24 business hours of admission for each Veteran.

f) The ISP will be consistent with low demand program goals; the plan must specifically include provisions for Veteran placement into permanent housing placement within 90 days of admission to the HCHV Contract Residential Care Facility with no more than 180 days without clinical justification.

g) The housing placement planning must consider all appropriate and available community-based housing options and the Veteran’s preferences regarding the location and housing type.

h) The ISP ‘s must be reviewed every thirty (30) days after that in a clinical meeting with the Veteran, and updated plans must be promptly communicated to the VA Liaison changes in the plan will be made during consultation with the Veteran.

i) The plan must focus on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, and focus on getting the Veteran(s) to accept services, especially mental health and substance use services, professional and vocational rehabilitation counseling. VA programs and community resources will allow attainment of transitional or permanent housing.

j) Acceptance of the services offered should not be a condition of continued stay. Nevertheless, engagement and service delivery should retain the expectation that the Veteran will advance to permanent housing with support, recognizing that it will often be at his/her own pace.

k) Special attention will be paid to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff, and the contractor’s Case Manager. Every week the contracted case manager will be required to update the VA Liaison on Veteran’s progress and safety concerns for HSR Veterans.

l) The contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart.

m) All Veterans will be referred to VA for Primary Care and Mental Health appointments. Particular efforts will be made for Veterans who are identified by VA Liaison to be highly acute. Efforts will be documented in the Veterans ISP and reviewed by the VA Liaison at least monthly.

n) The Contractor will provide proper documentation verifying services and case management efforts by all team members including, but not limited to housing benefit, and employment specialists, and program management staff.

7) PERMANENT HOUSING SEARCH:

a) The Contractor will take primary responsibility for assisting Veterans in completing housing applications and other benefits paperwork as needed. Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans transition to permanent housing placements must be reflected in each ISP and in weekly case management notes, which will consist of assisting Veterans in obtaining the needed documentation required for complete applications such as birth certificates, driver’s license, income verification, identification, and any additional information needed by housing resources and potential income supports.

b) As part of this plan, Veterans’ housing history and needs must be assessed through a formal and through Housing Assessment completed within 24 business hours of program admission.

c) The housing assessment will identify Veterans’ housing history, strengths (i.e., positive prior rental history), barriers (i.e., Unlawful Detainers).

d) If a Veteran refuses to participate or engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veterans regarding housing plans, options, and resources shall be documented and include what therapeutic methods were utilized.

e) Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and assessing appropriate housing resources by accompanying Veterans to housing interviews while working with Veterans to foster independence and a sense of self-determination as proper. The Contractor will provide transportation for Veterans for potential housing placements.

f) Examples of direct assistance include:

i) Assistance obtaining and reviewing Veteran’s free credit report;

ii) Identifying housing strengths and barriers associated with current credit status;

iii) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsides, etc.;

iv) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications;

v) Conduct regular and individualized housing advocacy efforts, including transportation, assistance scheduling meetings, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denial occur in the housing search process;

vi) Explore housing options in low-rent areas.

g) All housing efforts by Contractor shall be documented clearly and presented to VA Liaison upon request. Mere communication with Veterans regarding housing without subsequent Contractor staff action and follow-up shall not rely on its merit the above requirement.

h) Veterans with Sex Offender status will have increased focus on discharge to stable or permanent housing placements as evidenced by ISP.

8) FINANCIAL PLANNING:

a) Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g., SSI, SSDI, Food Stamps, NSC pension, SC compensation, etc.) shall occur within the first 30 days of admission. Case Managers will document all structured activities that support Veterans in developing a short and long-term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in a group but preferably through one on one case management services. At a minimum, four financial planning activities appropriate to the Veteran’s circumstance must be documented monthly.

9) EMPLOYMENT SERVICES:

a) Provide referral to all relevant employment opportunities the Veteran is eligible for and interested in. Case managers will document all structured activities that support Veterans in applying for employment as appropriate based on Veterans’ needs identified in the assessment. At a minimum four employment planning activities relevant to the Veteran’s circumstance must be documented monthly.

10) RECOVERY:

a) The Contractor will provide onsite therapeutic and rehabilitative services, including support for an alcohol/drug abuse-free lifestyle and promote structured groups and activities to enhance social skills, interactions, building healthy lifestyles but not mandatory. Supportive social services, in collaboration with case managers, VA, and community resources to assist in a supportive recovery model such as a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Opportunities for drug testing may not be used to admit, discharge, or discipline a Veteran. They can be used for immediate learning and development of responsible living to modify behavior to achieve a more adaptive level of psychosocial functioning.

11) CRITICAL INCIDENT REPORTING:

a) All critical incidents will be reported to the VA Liaison or Designee within 24 hours which, includes the following:

i) Falls

ii) Assault (to Veteran or Staff)

iii) Elderly/Dependent Adult Abuse or Neglect

iv) Sexual Assault

v) Fire (Veteran Involved)

vi) Medical/Psychiatric Emergency (911 Calls)

vii) Hospitalization

viii) Suicide or Suicide Attempt

ix) Homicide

x) Death

xi) Drug/Police Raid

xii) Medication Problem

xiii) Infectious Control (bed bugs, TB, etc.)

xiv) Active Substance Abuse

xv) Observation/Possession of Weapons

xvi) MIA/AWOL

12) DOCUMENTATION:

a) The Contractor shall provide treatment and discharge planning that reflects a team-based assessment of health, social, and vocational needs with the Veteran’s involvement, the VA Liaison, and appropriate community resources in resolving problems and setting goals via the ISP. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Record (42 CFR part 2) and Certain Medical Records’ Confidentiality (38 USC 7332). As VA exercises contract oversight, attention will be directed to the adequacy of Veteran’s records according to State or community licensing standards and will be made available on a need-to-know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). Site visits by VA staff will periodically include a spot check of records to ensure Contractor invoices reflect the Veteran’s length of stay.

b) The Contractor will be responsible for the files of Veterans, which shall include:

i) An individual clinical record on each Veteran housed under this contract.

ii) Reasons for referral, data relevant to the Veteran’s admission, and anticipated length of stay.

iii) All essential identifying data relevant to the Veteran and his/her family, including a socio-cultural interventions or Veteran care conferences.

iv) Medication Management/Monitoring- Copies of any medical prescriptions included by physicians, including orders, if any, for medications to be taken. The Contractor must comply with HCHV medication inspection requirements.

c) There will be an expectation that notes are written professionally in a format that utilizes the precise settings of goals and documents progress toward those goals (e.g., SNAP, SOAP, OR SMART, DAP). The Contractor will be responsible for including the following: 1) A written thorough Housing Needs Assessment, 2) Financial Plan, 3) Discharge Plan and Individual Service Plan with attenable goals and documented activity indicating Veteran and Case Manager are actively working on identified goals.

d) Treatment plans must meet requirements of The Joint Commission (TJC) and Commission on Accreditation of Rehabilitation Facilities (CARF).

e) Final summaries on each resident who leaves the program, including reasons for leaving, the resident’s plans, and follow-up locator information.

f) Contractors will be expected to enter data into a Homeless Management Information System (HMIS) web-based software application and bed totals in the Homeless Inventory Count. The data will consist of information on the Veterans served and types of supportive services provided by Contractors. Contractors must treat the data for activities funded by the VA HCHV Contract Residential Care program separately from activities funded by other programs. Contractors will be required to export client-level data for activities funded by the VA HCHV Contract Residential Care program to VA regularly.

13) ELIGIBILTY, REFERRALS, AND ADMISSIONS:

The contractor is responsible for notifying the identified VA Liaison (or designee) within 24 business hours. that an admission or discharge has occurred, and for providing a written report for documentation of entry and discharge in the Homeless Operations and Management Evaluation System (HOMES) within 48 business hours.

a) Eligibility:

i) To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3.:

ii) Contractor will prioritize individuals experiencing chronic homelessness as defined by the HUD, including Veterans diagnosed with severe mental illness and substance use disorders. Contractor can accept Veterans who are not chronically homeless.

iii) The VA is responsible for determining Veterans’ eligibility before acceptance by the Contractor services. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff is required (hard copy, fax, or e-mail are acceptable) and shall be provided to the Contractor for each Veteran referred for services under the contract.

iv) The provider staff should contact the WVAMC eligibility office to verify Veteran eligibility status during non-business hours. If unable to confirm during non-business hours, a homeless person should be accepted conditionally. The Contractor must notify VA Liaison of admission that occur outside of non-business hours immediately the next business day.

v) Within 3 business days of admission, VA clinical staff will meet with the newly admitted individual and complete a joint assessment with contractor staff. If glaring safety issues arise before the joint meeting, the decision to exit an individual based on safety concerns will be deferred to the contractor. VA staff cannot approve payments for services provided to unauthorized/ineligible Veterans.

vi) If within 72 hours of admission, the homeless individual is found to be ineligible for VA healthcare, the Contractor will initiate referrals to alternative placements and transition the homeless individual to this placement.

vii) If within 2 hours of admission a Veteran displays physical evidence of infectious disease and test positive for such, the decision to transition this individual to alternative placement will be deferred to the Contractor.

viii) If within 72 hours it is determined that the level of care is not appropriate, the Contractor will collaborate with the Veteran and VA to arrange care through other VA or community resources.

ix) Contractor must have the ability to accommodate the following:

(1) Veterans with ambulatory difficulties including wheelchairs and other assistive devises in compliance with American with Disabilities Act Accessibility Guidelines.

(2) Veterans participating in opioid treatment programs.

(3) Veterans with medical issues that do not meet criteria for inpatient medical or nursing home services. NOTE: The Contractor is not expected to provide home health aide or skilled nursing services. However, the Contractor must not deny admission based on the need for in-home services if services are provided by VA or another outside agency. Examples include medication administration, wound care, assistance with activities of daily living (including bowel/bladder incontinence).

(4) The needs of special populations, including OEF/OIF/OND, severe mental illness, and chronically homeless, will be prioritized. VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that are fair, objective, and compliant with applicable State and Federal laws.

x) The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. To be eligible for placement in emergency contract beds, all Veterans mut be homeless or at imminent risk of becoming homeless and be eligible and registered for VA services.

xi) It is understood that Veterans with stabilizing medical, mental health, substance abuse, and other psychosocial problems will require care and treatment services over and above the level of room and board. It is understood that Veterans may need more intensive case management than the general population.

xii) This population of Veterans that require intensive case management may consist of but is not limited to medically compromised Veterans, those with sex offender status, seriously mentally ill, who have abused drugs or alcohol for many years, and Veterans who have been involved with the legal system. However, a formal diagnosis is not required for the Veteran to participate in the program.

b) Referrals/Admissions:

i) The Contractor must have a dedicated phone line for VA inquiries and referrals. Return calls from the contractor are expected within 2 hours during business hours Monday through Friday, including calls from VA Liaison or Staff to the program.

ii) The Contractor shall have the ability to accommodate immediate admissions 24 hours per day, seven (7) days per week unless there are no available beds. The date of admission must be approved by the VA Liaison for billing purposes. If a Veteran presents at the facility during weekends, at night, or on holiday, the contractor may accept the Veterans. However, VA staff has the right to approval or disapproval for payment. The engagement of homeless Veterans in housing placement, treatment, and supportive services is a crucial element of the HCHV Contract Residential Care program.

iii) The contractor shall comply with the VA patient’s Bill of Rights as outlined in Section 17.34a, Title 38, Code of Federal Regulations. The Contractor is responsible for maintaining Veterans’ privacy and confidentiality and must have systems in place that protect Veteran’s personal identifying information and protected health information, which includes but is limited to the following: having adequate private office space for Veterans to meet in confidence with their case manager; having secured paper and electronic filing systems to protect clients’ case records and other documentation; conducting ongoing training of staff about maintaining client privacy and confidentiality in all verbal and written communications and interactions; ensuring that non-clinical/non- case management facility staff have access to Veteran information only as needed to meet the service requirements contained in the contract.

iv) Veterans cannot be denied entry to HCHV CRS based solely upon the length of current abstinence from alcohol or non-prescribed controlled substance, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, gender, or legal history. Including a Veteran’s status of being a victim of Domestic Violence cannot be considered during the screening process. The screening process must consider each of these exceptional circumstances and determine whether the program can meet the individual Veteran’s needs while maintaining the program’s safety, security, and integrity. All Contractors must employ a harm reduction approach.

c) Intake Packets:

i) These policies and procedures must be communicated to Veterans both verbally and in writing. All Veterans must receive and sign a receipt for an intake packet within 72 business hours of admission to the facility and the communication documented in the Veteran’s client record, which includes at minimum, the following information:

(1) Description of Contractors Services

(2) Rules and Regulations

(3) Veterans Rights and Grievance Policy

(4) Emergency Procedures

(5) Reasonable Accommodation Policy

ii) House rules and expectations should be kept to a minimum, be simple, and should focus on the safety of the Veterans and staff. Most Veterans may have had difficulty in the past adhering to the settings where strict rules are applied. The rules should reward positive behavior, be enforceable, relate to the living situation, provided for the Veteran’s safety, and provide opportunities for engagement. Veterans will not be discharged for the use of alcohol or drugs. Many Veterans that this program will target have failed programs in the past for their inability to stay clean and sober. Maintaining housing stability will be the primary goal for each Veteran. To provide for the safety of the Veteran(s), the Contractor must have written policies and procedures in place that indicate the following are prohibited:

(1) Dealing or use of illicit drugs/alcohol at the facility;

(2) Buying or selling of alcohol or drugs in the facility;

(3) Sexual activity between Veterans (including kissing and holding hands);

(4) Violence or threat of violence toward Veterans or facility staff;

(5) Destruction of facility property;

(6) Possession of weapons

14) TIME FRAMES:

a) If a Veteran’s length of stay exceeds 180 days from the date of admission and there is no approval from the VA Liaison for continued per diem, the Contractor will retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense.

b) The initial stay for a Veteran in Residential Contract Service is determined by the need of each Veteran. There shall be no minimum stay criteria for admissions. It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral unless an extension of the authorization is provided in writing by the VA.

c) The initial length of stay for a Veteran should be no longer than 90 days. Some Veterans may be considered for up to 180 days depending on the Veteran’s needs as mutually determined by the Veteran, Contractor, and VA Liaison. Any extension of the stay after 180 days must be authorized by the VA Liaison or Designee, provided that there is a clear clinical indication and availability of funds. Only extraordinary circumstances will be considered to extend Service periods over 180 days for individual Veterans, and these must be authorized by the VA Liaison or Designee.

d) Expediting placement of these Veterans into safe and supportive emergency housing is expected of this contract. After stabilization, Veterans should be placed in other appropriate permanent housing quickly (within 90 days) with no more than 180 days without a planned reason for the extension. The VA Liaison will not approve per diem for a length of stays exceeding 180 days from the date of admission unless:

i) There are extenuating clinical circumstances beyond the Contractor’s control that are barriers to the Veteran’s placement in housing; and

ii) There is documented evidence that the Contractor has exhausted every effort to place the Veteran in housing sooner; and

iii) The VA Liaison has been appropriately advised of these efforts well in advance of the 180-day limit; and

iv) The VA Liaison concurs that the Veterans will continue to derive therapeutic benefits from a continued stay at the HCHV Contracted Residential Care facility.

v) An extension of the length of stay may be authorized by the VA Liaison, provided funding is available. The transition timing to the community is mutually determined by the Veteran, the Contractor, and VA Liaison. The Contractor is responsible for ensuring that access barriers to housing and continuing outpatient care (e.g., distance, transportation, scheduling) are reduced or eliminated.

15) DISCHARGE PLANNING:

a) Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Veterans must maintain a minimum of two appropriate housing placement applications until permanent housing is obtained. The Contractor must provide computer and telephone access for Veterans to assist with discharge planning and case management needs. The case manager will assist with discharge planning for every Veteran and report all discharges via email within one business day using a secured process (e.g., HOMES ID number). HOMES exit form is required for discharging a Veteran from any HCHV program via fax or secure email within 1 business day from known discharge. Contractor will provide program exit summary upon termination from the program for each episode of care. Medical Case and services provided, and recommendations for follow-up care, shall be documented in this exit summary, which shall include at a minimum: date of exit, type of exit, Veterans perception of exit and agreement with exit, status of treatment goals at time of exit and aftercare plan. Housing needs will be assessed upon acceptance to the program and resources will be coordinated for discharge to a successful community placement throughout the Veteran’s stay. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison before discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with the team is determine Veterans’ most therapeutic options, including violations for safety reasons or verbal abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the VA Liaison to schedule an appeal.

b) The Contractor must post rules in the Veterans Case Manager’s Office and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. The Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions, or discharges. This information must be provided to Veterans in writing upon intake via rules and regulations and grievance policy and must be clear and easily understandable by Veterans. This information shall include:

i) Immediate contact with VA Liaison

ii) Timely due process provisions should include two warning notices for violations that do not result in immediate discharge before issuance of a discharge notice and an opportunity for a case conference after the warning is issued to the client.

iii) Notice of and access to formal appeal procedures.

iv) Notice of the conditions or process for re-admission to the program.

v) Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed. This does not apply to Veterans who are discharged for danger to themselves or others.

c) Veterans may be discharged from HCHV Contract Residential Care programs for positive, negative, or administrative reasons. The date of discharge must be approved by the VA Liaison for billing purposes. The Contractor shall provide discharge planning and referrals for each Veteran, regardless of the character of discharge from the facility to appropriate community resources and services based upon a team assessment of health, social, and vocational needs, and the involvement of Veterans’ families appropriate. Discharges will be characterized as follows:

i) Positive Discharge - The Veteran has been successfully placed as anticipated permanent housing or reunited with family/friends and has met the goals of his/her ISP within 180 days from the date of admission or date VA Liaison has approved the continuation of per diem payment.

ii) Administrative Discharge – The Veteran has been transferred to an alternate level of care with concurrence from the VA Liaison for medical, mental health, or substance abuse treatment to meet the Veteran’s clinical needs better.

iii) Negative Discharge – The Veteran has absconded from the facility, and his/her whereabouts are unknown; the Veteran has had an episode of violence or has threatened violence against staff or other Veterans and must be discharged to maintain the safety of the facility; the Veteran has had more than one episode of onsite drug use/possession at the facility, has failed to engage in or accept treatment alternatives, and must be discharged to maintain a safe and sober environment at the facility; or the Veteran’s length of stay has exceeded 180 days from the date of admission, and the VA Liaison has not approved the continuation of per diem payment.

iv) Unacceptable Discharge – The Veteran is discharged to a homeless shelter or drop-in setting after a length of stay greater than seven (7) days from the date of admission unless there is concurrence from the VA Liaison that there is no other alternative due to circumstances beyond the Contractor’s control or the Veteran is discharged to the streets at any point in time after the date of admission under any circumstances.

d) Performance Expectations regarding discharges will be as follow:

16) ABSENCES AND CANCELLATIONS:

a) The Contractor shall notify the VA Liaison of unauthorized absences by a referred Veteran from the facility within 2 hours during business hours or immediately the next business day if an absence occurs during non-business hours. Should a Veteran absent himself/herself from the Contractor’s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of 48 hours, provided there is a concurrent documented active outreach attempt on the part of the Contractor’s staff to return the Veteran and there is a reasonable belief that the Veteran will return. The VA Liaison may authorize payment for excused absences if there is a compelling medical or mental health needs and the excused absence is verified in advance. Absences of the Veteran from the facility will not be reimbursed after 48 hours but do not have to discharged unless the absence is greater than 14 days or if the absence is authorized and there is no expectation that the Veteran will return to the facility as determined by the VA Liaison.